Abstract
To evaluate theclinical significance of Mastora obstruction score in hemodynamically stable patients with acute pulmonary embolism (aPE). One-hundred-and-six patients with newly diagnosed aPE, confirmed by computed tomography pulmonary angiography (CTPA), were included in thestudy and prospectively examined. aPE severity was assessed by using Mastora obstruction score. According to theMastora index, patients were divided into "non-massive" and "massive" groups. The patients' medical histories and blood laboratory data were collected, and instrumental tests were performed and analyzed. Eighty-two (77%) of thepatients had "non-massive" aPE. Cough (48%), fever (44%), and pleural effusion (48%) occurred significantly more often in the "non-massive" PE group, while syncope (42%) and right ventricular dysfunction (86%) were more frequent in the "massive" PE group. The probability of the right ventricular dysfunction was significantly higher in the presence of increased pulmonary artery pressure (Cramer's V=0.410; p<0.0001) and respiratory failure (Cramer's V=0.247; p=0.032). Increased CRP level was found in themajority of thepatients (90%). D-dimer level <500 μg/L (lower than thecommonly recommended cut-off level) was found in 5% of cases. Theclinical manifestation depends on themassiveness of aPE. Division of aPE cases into two groups suggests two possible subtypes of aPE: cardiovascular and respiratory. The"non-massive" aPE was associated with respiratory symptoms and an inflammatory response. The "massive" aPE is associated with an increased D-dimer level and leads to cardiovascular disorders. However, the"massive" aPE may be presented by normal D-dimer concentration level.
Highlights
Acute pulmonary embolism is a life-threatening fatal disease with an annual incidence of 70 cases per 100 000 inhabitants [1, 2]
Syncope and right ventricular dysfunction were more frequent in the “massive” Acute pulmonary embolism (aPE) group
The key findings in our study are: (i) clinical and laboratory manifestation of aPE depends on “massiveness” of the thrombosis of the pulmonary arteries; (ii) “massive” aPE more often presented with syncope, right ventricular dysfunction, higher level of D-dimer; (iii) “non-massive” aPE mostly presented with cough, fever, pleural effusion, higher level of CRP; (iv) the normal level of D-dimer did not exclude aPE, even massive one
Summary
Acute pulmonary embolism (aPE) is a life-threatening fatal disease with an annual incidence of 70 cases per 100 000 inhabitants [1, 2]. It is the third most frequent cardiovascular disease with an overall annual incidence of 100–200 per 100 000 people [3]. Massiveness of aPE has been defined on the basis of angiographic burden of emboli by use of the radiologic indexes designed for PE severity, such as Qanadli, Miller, or Mastora score [9, 10]. The aim of the study was to analyze the significance of Mastora obstruction score in hemodynamically stable aPE. To evaluate the clinical significance of Mastora obstruction score in hemodynamically stable patients with acute pulmonary embolism (aPE)
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